Be aware that your entry fee does not include crew members

Event Date: 17TH MAY 2015
PLEASE WRITE CLEARLY.
Entrant Name: __________________________________
Surname: _________________________________________________
Address:
__________________________________
Suburb:
Contact Ph:
__________________________________
Email: ____________________________________________________
Vehicle Details:
_______________________________________________ Engine Capacity: ________________________________
_______________________ State: ________ P/C ________
ANDRA Race Number _________________________
Please nominate your vehicle class. No Day licences issued for super street, must be ANDRA licence holder.
$70.00 (No Crew)
 Street Vehicle
 Street Bike
$ 80.00
 Junior Dragster
$120.00
 Super Street
 Super Sedan
 Super Gas
$120.00
 Modified Bike
 Modified
$120.00
 S/Charged Outlaw
 Super Comp
 Top Sportsman
 Day Licence **$20.00 Required For All Street Registered Vehicles/Bikes for Non Andra Registered racers**
Be aware that your entry fee does not include crew members.
Please purchase separately and nominate below.
Crew Allocation (as per ANDRA rule book) _______
@
$20.00 =_________
Total Amount payable for 17th May $ _________________________
Entry will need to be paid for when submitted. No crew will be allocated on the day.
Running in street meeting format, no eliminations, no competition format. Competition cars or bikes will run
competition cars or bikes in respective brackets or street versus street. Licencing permitted at this event.
Bank Details
please provide surname as reference
Account Details: Racing Onn Promotions
BSB: 065-189 (Commonwealth Bank)
Account No: 1004 4535
Account Name: Racing Onn Promotions
Send entry Form to
P O Box 154,
Angle Vale SA 5117
Or scan and email to
[email protected]
Racing Onn Promotions, P O Box 154, Angle Vale SA 5117 Ph 0419 722 464
Window
Number
E.S.P. COMPETITOR DECLARATION
Credentials will close at 11am on race day. No crew allocations will be allocated after this time.
Part A
Event Dates ____________________________
First Name _________________________________
Class ____________________________________
Bracket: ___________________________________
Part B
Category 1
Safety Critical
Surname ____________________________________
ANDRA Licence Number _________________________
Category 2
Safety Non Critical
Category 3
Class Compliance & Non Safety
(White box is for ANDRA officials, Grey box is for competitors)
Helmet
Protective Clothing
Safety Harness
Roll Over Protection
Bellhousing/Auto Trans Shield
Fuel Shutoff
Supercharger restraints
Engine & Transmission
Clutch & Flywheel
Neutral Safety Switch
Wing Mounts
Fuel Tank/Cell/Lines
Liquid Overflow
Lower Eng Cont. Devices
Engine Capacity & Components
Transmission Type
Body Dimension & Aerodynamics
S/Charger Overdrive/Size/Type
Electronic devices
General Vehicle Presentation
Completion Number & Class
Display
Fuel Blend ______________
Steering Systems
Cooling Systems
Suspension Systems
Battery/Mounting
Seat & Mountings
Battery isolation Switch
Wheels/Tyres
Lubrication System
Lanyard/Ignition
Firewall
Blower Belt Guard
Tailshaft Loop
Technical Inspection
Cylinder Head Restraints
Vehicle Weight ___________________
Throttle Return
Fire Extinguisher
Fire System
Breaking System
Parachute/s
Clutch/Chain guard
Wheelie Bars
For clarification, please refer to supplementary regulations under “ESP Extended Scrutineering Declaration”
This form is to be presented for scrutineering on race day.
Part C
I, the competitor noted in Section A, state that I or may Agent have inspected the entered vehicle against all items ticked
in Part B of this form, and confirm that the vehicle complies with all relevant minimum safety and class eligibility requirements of the ANDRA
Competition Regulations, and that the vehicle will be made available for Compliance Audit/s if requested, and I am aware that where any breach of, or
non-compliance with these regulations is found during Compliance Audit I render myself liable to the penalties noted in Section 6.2 of the ESP Policy
and/or Tribunal Action and my signature below indicated my acceptance of these conditions.
Signature of competitor _____________________
Witness Name_____________________________
Witness Signature _________________________
ANDRA Official Signature ___________________
Date:
__________________________________
Position
__________________________________
Time
__________________________________
Officials Name _______________________________
Racing Onn Promotions, P O Box 154, Angle Vale SA 5117 Ph 0419 722 464
EXCLUSION OF LIABILITYREALEASE AND ASSUMPTION OF RISK ENTRANTS/DRIVER/RIDERS.
I/We being the entrants and/or driver and/or rider, certify that the particulars of this entry form are true and correct in every particular, to the
best of my/our knowledge and belief.
I/We declare that I/We have read and understood the supplementary regulations issued for the event, and agree to be bound by them and the
provisions of the competition rules of the Australian National drag Racing Association Pty Ltd (ANDRA Ltd).
In exchange for being able to enter, attend or participate in the event I/We agree:
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To release ANDRA Ltd, promoters, sponsor organisations, land owners and lessees, Racing Onn Promotions, their respective servants, officials,
representatives and agents (collectively, the Associated Entities”) from all liability for my death, personal injury (including burns),
psychological trauma, loss or damage (including property damage) (“harm”) howsoever arising from my participation in or attendance at the
event, except to the extent prohibited by law:
That ANDRA and the Associated Entities do not make any warranty, implied or express, that the event services will be provided with due care
and skill or that any materials provided in connection with the services will be fit for the purpose for which they are supplied: and
To attend or participate in the event at my/our own risk.
I/We acknowledge that:

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The risks associated with attending or participating in the event include the risk that I may suffer harm as a result of:
Motor Vehicles (or parts of them) colliding with other motor vehicles, persons or property:
Acts of violence and other harmful acts (whether intentional or inadvertent) committed by persons attending or participating in
the event: and
The failure or unsuitability of facilities (including grant-stands, fences and guard rails) to ensure the safety or persons or property at
the event.
Motor sport is dangerous and that accidents causing harm can and do happen and may happen to me/us
I/we accept the conditions of, and acknowledge the risks arising form, attending or participation in the event and being providing with event
services by ANDRA Ltd and the associated entities
Conditions of Entry
I have read the “Motorsport is dangerous and supplementary regulations” issued for this event and agree to be bound by them and the rules of
the Australian National Drag Racing Association, (ANDRA) I also acknowledge and agree as a condition of entry that neither the Australian
National Drag Racing Association, (ANDRA) nor the promoters Racing Onn Promotions Pty Ltd, nor the sponsor organisations, nor the land owners
Adelaide International Raceway Promotions Pty Ltd and Adelaide International Raceway, nor the organisers of the event, nor their respective
servants, official , representatives or agents (all of whom shall collectively be called the (“Organisers”) shall be under any liability for my death, or
any bodily injury, loss or damage which may be sustained or incurred by me as a result of participation in or being present at the event except in
regards to any rights I may have arising under the Trade Practices Act 1974. I acknowledge that motor racing is dangerous and that accident
causing death, bodily injury, disability and property damage can and do happen
Signature __________________________
Date
_____________
PARENT/GUARDIAN CONSENT – PERSONS UNDER 18 YEARS OF AGE
Where the driver/rider is under the age of 18 years the following Parent/Guardian Consent must be completed.
I ______________________________________________________________________________________________ (please print)
of ______________________________________________________________________________________________ (address)
Am the parent/guardian of the above name (the minor) who is under 18 years of age, I have read this document and
understand its contents, including the exclusion of liability and assumption of risk, and have explained the contents to the minor. I consent to the
minor attending/participating in the event at his/her own risk.
Parent/Guardian Signature
________________________________ Date
___________________________________
Racing Onn Promotions, P O Box 154, Angle Vale SA 5117 Ph 0419 722 464